Inequalities in Cancer Outcomes Network (ICON), Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Epidemiology of Cancer Healthcare and Outcomes (ECHO), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.
Br J Cancer. 2024 Jun;130(12):1960-1968. doi: 10.1038/s41416-024-02688-6. Epub 2024 Apr 26.
More deprived cancer patients are at higher risk of Emergency Presentation (EP) with most studies pointing to lower symptom awareness and increased comorbidities to explain those patterns. With the example of colon cancer, we examine patterns of hospital emergency admissions (HEAs) history in the most and least deprived patients as a potential precursor of EP.
We analysed the rates of hospital admissions and their admission codes (retrieved from Hospital Episode Statistics) in the two years preceding cancer diagnosis by sex, deprivation and route to diagnosis (EP, non-EP). To select the conditions (grouped admission codes) that best predict emergency admission, we adapted the purposeful variable selection to mixed-effects logistic regression.
Colon cancer patients diagnosed through EP had the highest number of HEAs than all the other routes to diagnosis, especially in the last 7 months before diagnosis. Most deprived patients had an overall higher rate and higher probability of HEA but fewer conditions associated with it.
Our findings point to higher use of emergency services for non-specific symptoms and conditions in the most deprived patients, preceding colon cancer diagnosis. Health system barriers may be a shared factor of socio-economic inequalities in EP and HEAs.
更贫困的癌症患者发生紧急就诊（EP）的风险更高，大多数研究指出，这与较低的症状意识和更多的合并症有关。以结肠癌为例，我们研究了最贫困和最不贫困患者的住院急诊就诊（HEA）史模式，作为 EP 的潜在前兆。
我们分析了在癌症诊断前两年内，按性别、贫困程度和诊断途径（EP、非 EP）对住院次数及其入院代码（从医院就诊统计中检索）进行分析。为了选择最能预测急诊入院的条件（分组入院代码），我们对混合效应逻辑回归进行了有针对性的变量选择。
通过 EP 诊断的结肠癌患者的 HEA 数量高于所有其他诊断途径，尤其是在诊断前的最后 7 个月。最贫困的患者总体上有更高的 HEA 发生率和更高的 HEA 可能性，但与 HEA 相关的条件较少。
我们的研究结果表明，在诊断结肠癌之前，最贫困的患者更倾向于使用紧急服务来治疗非特异性症状和疾病。健康系统障碍可能是 EP 和 HEA 中社会经济不平等的共同因素。
